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HumanaChoice - Diabetes and Heart (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice - Diabetes and Heart (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice - Diabetes and Heart (PPO C-SNP) in 2026, please refer to our full plan details page.
HumanaChoice - Diabetes and Heart (PPO C-SNP) is a PPO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Georgia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice - Diabetes and Heart (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HumanaChoice - Diabetes and Heart (PPO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice - Diabetes and Heart (PPO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice - Diabetes and Heart (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $450.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9250.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9250.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for HumanaChoice - Diabetes and Heart (PPO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan features an annual drug deductible of $450. Under this plan, you will enjoy no copay for Tier 1 preferred generics at standard pharmacies and through preferred mail order, as well as no copay for Tier 6 select care drugs across all standard and mail order options. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at standard pharmacies or preferred mail order, with no copay for a three-month supply when using preferred mail order. For Tier 3 preferred brand drugs, copays are $47 for a one-month supply, though you can save on a three-month supply by using preferred mail order for a $94 copay instead of the standard $141. Tier 4 non-preferred drugs require a 49% coinsurance across all pharmacy options, while Tier 5 specialty drugs carry a 27% coinsurance for a one-month supply.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers robust coverage with many essential services featuring no copay and no coinsurance, including primary care visits, routine eye exams, and preventive dental care. For other medical needs, the plan provides predictable copayments, such as $40 for specialist visits, $115 for emergency room care, and up to a $3,000 annual maximum allowance for dental services. Inpatient hospital stays require a daily copay for the initial days but transition to no copay for longer stays, while home health care is available with no copay or coinsurance. For specialized medical needs, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $375 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $375 daily copay for days 1-5 and no copay for days 6-90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $450 (including $375 per stay for observation services), while outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance, while routine transportation services to health-related locations are not covered. Prior authorization is required for all ambulance services, and the copayment is not waived if you are admitted to the hospital.
Emergency Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Other benefits include physical, occupational, and speech therapies for a $25 copay, mental health and psychiatric services for a $35 copay, and podiatry for a $35 to $40 copay, all with no coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay and no coinsurance for annual physicals, kidney disease education, select screenings, and fitness benefits. However, additional preventive benefits are only partially covered. Excluded sub-services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, bathroom safety modifications, and counseling.
Hearing Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers hearing exams with a $40 copay and no coinsurance for Medicare-covered exams, while routine annual exams and OTC hearing aids are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $799 for up to two devices per year, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance or deductibles, featuring a $0 to $40 copay for eye exams (no copay for routine exams) and no copay for eyewear. While routine exams (up to $75 annually) and contact lenses or eyeglasses (up to $150 annually) are covered, prior authorization is required, and other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers partially covered dental services with an annual maximum benefit of $3,000 for both in- and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, carry a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, offering lab tests at no copay and other procedures with a $0 to $120 copay, while radiological services range from no copay for X-rays to a minimum 20% coinsurance and minimum $40 copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance and prior authorization required, though some services are not covered. Specifically, Cardiac Rehabilitation (with a $30 copay), Intensive Cardiac Rehabilitation ($30 copay), Pulmonary Rehabilitation ($25 copay), and Supervised Exercise Therapy for PAD ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers partially covered other services, including acupuncture for a $40 copay and no coinsurance for up to 20 treatments per year, and over-the-counter items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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